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General NPI Number Information
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NPI Number | 1942338256
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Entity Type | Organization
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Legal Business Name | PARK RIDGE ORTHOPEDIC SURGEONS,S.C.
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 7447 W TALCOTT AVE SUITE 515
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City | CHICAGO
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State | IL
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Zip | 60631-3745
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Country | US
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Telephone | 773-774-3501
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Fax | 773-774-3511
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Provider Business Mailing Address
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Address Line | 7447 W. TALCOTT RD. SUITE 515
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City | CHICAGO
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State | IL
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Zip | 60631-3745
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Country | US
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Telephone | 773-774-3501
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Fax | 773-774-3511
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Authorized Official
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Title or Position | MANAGER
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Name | JAN M DACZKEWYCZ
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Credential | B.S.
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Telephone | 774-774-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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